I. Indications

  1. Cervical dilation prior to Dilation and Curettage

II. Advantages

  1. Safe and effective
  2. Less cervical trauma and pain than with dilator

III. Preparations

  1. Laminaria digitata
    1. Seaweed stem of 2-3 mm width
    2. String attached to end for removal
    3. Swells on contact with water
      1. May reach up to 5x its original width in 12 hours
  2. Synthetic alternatives to Laminaria
    1. Dilateria
    2. Lamicel
    3. Dilapan

IV. Procedure

  1. Prepare Cervix
    1. Expose Cervix with medium Graves speculum
    2. Use antiseptic over Cervix and posterior fornix
    3. Apply single toothed tenaculum to anterior Cervix lip
  2. Insert uterine sound just past cervical os
    1. Opens cervical os to allow for insertion of Laminaria
    2. Helps determine cervical orientation
    3. Do not fully insert
      1. Not necessary to determine uterine depth
  3. Insert Laminaria
    1. Hold tenaculum to steady Cervix
    2. Hold Laminaria with ring forceps and insert into os
    3. Allow Laminaria tip to pivot to find cervical canal
    4. Fully insert Laminaria into Cervix
    5. Consider placing second Laminaria next to first
      1. Indicated if Gestational age >11 weeks
    6. Remove tenaculum
      1. Apply sponge against Laminaria to prevent removal

V. Follow-up

  1. Leave Laminaria in overnight
  2. Remove Laminaria at time of Dilation and Curettage

Images: Related links to external sites (from Google)

Ontology: Laminaria (C0022980)

Definition (MSH) A genus of BROWN ALGAE in the family Laminariaceae. Dried pencil-like pieces may be inserted in the cervix where they swell as they absorb moisture, serving as osmotic dilators.
Concepts Eukaryote (T204)
MSH D007795
English Laminaria, Laminarias, laminaria, laminarias
Swedish Laminaria
Czech Laminaria
Finnish Laminaari
Russian LAMINARIIA, ЛАМИНАРИЯ
Japanese ラミナリア, コンブ属, コンブ
French Laminaire (algue), Laminaria
Polish Laminaria
German Laminaria
Italian Laminaria
Dutch Laminaria
Portuguese Laminaria
Spanish Laminaria

Ontology: Lamicel (C0064630)

Concepts Biomedical or Dental Material (T122)
MSH C034860
English lamicel, Lamicel

Ontology: dilapan (C0174425)

Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH C077755
English dilapan